Provider Demographics
NPI:1134369051
Name:MAXWELL L LARWEH (MD)
Entity type:Organization
Organization Name:MAXWELL L LARWEH (MD)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LARWEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-812-1125
Mailing Address - Street 1:19668 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-3747
Mailing Address - Country:US
Mailing Address - Phone:503-812-1125
Mailing Address - Fax:
Practice Address - Street 1:1870 S 75TH ST
Practice Address - Street 2:SELECT SPECIALTY HOSPITAL
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1700
Practice Address - Country:US
Practice Address - Phone:402-361-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty